Provider Demographics
NPI:1366405896
Name:FABROS, MILDRED GABOT (PA-C)
Entity type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:GABOT
Last Name:FABROS
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1333 S. MAYFLOWER AVENUE
Mailing Address - Street 2:2ND FL
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5266
Mailing Address - Country:US
Mailing Address - Phone:626-775-3514
Mailing Address - Fax:626-408-3911
Practice Address - Street 1:1500 DUARTE RD
Practice Address - Street 2:DIVISION OF RADIATION ONCOLOGY
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3012
Practice Address - Country:US
Practice Address - Phone:626-301-8247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2020-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17124363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant